Here’s a quick rundown on the most important things to know about the Health Insurance Marketplace, sometimes known as the health insurance “exchange.” Follow the links for more information on each topic.

The new Health Insurance Marketplace helps uninsured people find health coverage. When you fill out the Marketplace application we’ll tell you if you qualify for:

Private insurance plans. We’ll tell you whether you qualify for lower costs based on your household size and income. Plans cover essential health benefits, pre-existing conditions, and preventive care. If you don’t qualify for lower costs, you can still use the Marketplace to buy insurance at the standard price.

Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide coverage to millions of families with limited income. If it looks like you qualify, we’ll share information with your state agency and they’ll contact you. Many but not all states are expanding Medicaid in 2014 to cover more people.

No matter what state you live in, you can use the Marketplace. Some states operate their own Marketplace. In some states, the Marketplace is run by the Federal government. Find the Health Insurance Marketplace in your state.

Most people must have health coverage in 2014 or pay a fee. If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee.

You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.

If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums.

If you have Medicare, you’re considered covered and don’t have to make any changes. You can’t use the Marketplace to buy a supplemental or dental plan.

Marketplace open enrollment ends March 31, 2014. If you enroll by December 15, 2013, coverage can begin as soon as January 1, 2014.

I like facts, this is so important. As someone who paid a fortune for insurance with pre-existing conditions, I wish this had been in place 10 years ago. It is great for those who have COPD, do not have employer sponsored insurance and are not eligible for Medicare. The site is not that different than medicare.gov in purpose.

Thanks Dave although I doubt thát anyone who has a fear based hatred of this law will be interested in any facts. I worked for 2 years in Englewood in Chicago in order to be able to buy my way into a pension plan which offers supplemented insurance coverage. Englewood is one of the 3 neighborhoods here where the gsngs have made the city the "murder capital." 18 months after I bought into the pension I was diagnosed with a stage 3 cancer. Without insurance I would be dead now or at the very least, homeless.

Thanks for finally closing the topic on the support forum and opening it here. Better late than never.

Dave-- just my opinion--- I think this is a real hot button issue. My fear is that it will lead to more confrontation between people here on the Forum rather than support for each other. I think this item if discussed at all should be on a political forum not on support based forum. Thanks for listening. Paul

I think Obamacare is an important topic to discuss since it will affect all of us, but I don't think many of the members will find it here. Dave, it is a somewhat political issue, so it will be hard for politics not to enter some of the discussion. How else can we learn if we don't talk about it, and what experiences we may be having with it. I believe someone mentioned putting it on the support form with a sticky, and that would probably have made it easier to find.

We can discuss the insurance aspects of it without the political overtones. It is an insurance exchange, similar to the one on Medicare.gov. It helps you select and enroll in health insurance. There are technical issues they are trying to resolve. As a former software developer I can tell you that the web makes everything harder than on a PC network.

If people have questions about who, what, when or why, that is fine. If there are complaints about the process, that is fine. But the politics of it violates our legal obligations as a 503(c)(3). I will make this a sticky.

Top 5 things to know about the Affordable Care Act (ACA) if you have Medicare:

Your Medicare coverage is protected.

Medicare isn’t part of the Health Insurance Marketplace established by ACA, so you don't have to replace your Medicare coverage with Marketplace coverage. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now.

You don’t need to do anything with the Marketplace during Open Enrollment.

You get more preventive services, for less. Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly "Wellness" visit.

You can save money on brand-name drugs. If you’re in the donut hole, you'll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. The donut hole will be closed completely by 2020.

Your doctor gets more support. With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.

The ACA ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.

There are many important changes under the Patient Protection and Affordable Care Act of 2010 (ACA) that improve access and services for people with Medicare. Many of these changes will take place in 2011 - some even began as early as January 1. Below is a list of some of the changes beneficiaries will experience this year:

2. Improvements to Medicare Preventive Benefits

Annual Wellness Visit: Beginning January 1, 2011, people with Medicare have access to a new ‘Annual Wellness Visit' where they can receive a comprehensive health risk assessment and develop a personalized prevention plan.

Improved cost-sharing for Medicare preventive services: Also, as of January 1, the ACA also eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force. The services which now have no cost-sharing (if a doctor accepts assignment under Medicare, meaning he or she accepts what Medicare pays for a service as payment in full) include:

abdominal aortic aneurysm screening bone mass measurement breast cancer screening/mammograms cardiovascular screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor's visit) certain types of colorectal cancer screenings (i.e., flexible sigmoidoscopy and colonoscopy) diabetes screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor's visit) flu shots Hepatitis B shots HIV screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor's visit) medical nutrition therapy services (for those with diabetes or kidney disease, or who have had a kidney transplant in the last 36 months and whose doctor refers them for these services) Pap tests and pelvic exams physical exams - both the “Welcome to Medicare” visit and the annual “wellness visit” pneumococcal shot prostate cancer screening smoking cessation counseling

Smoking cessation counseling: More people are now eligible for the smoking cessation counseling benefit under Medicare. Now all beneficiaries who smoke can take advantage of as many as eight smoking cessation counseling sessions.

I think the following is also a provision of the ACA which affects Medicare:

Supplementary insurers who don't spend 80% or more of the collected premiums on benefits rather than administrative costs (advertising, salaries, etc.) must refund a portion of those premiums to the insured. For example, in Illinois last year, AARP United Health Care was required to refund $120 to its Medicare customers while Blue Cross was not required to refund anything.

It is curious in that when comparing the two plans, United on paper looks so much better for the insured because, for just about everything, it covers 100% of the 20% Medicare does not cover while Blue Cross covers 80% of that 20%. Yet, United had to refund some of the premiums collected. So, how did United not spend as much as Blue Cross on benefits?

The info wrt which insurers must pay a refund is publicized on the Internet.

One other thing, while there is no co-pay for the colonoscopy procedure, I believe the usual co-pay under the particular insurance plan applies to the removal of polyps and the pathology exam of those polyps. I will know more when I receive the bills from the hospital and doctor for the colonoscopy I had last month when 5 polyps were removed.

Rosy People want insurance. One of the problems has to do with the fact that millions of people, Millions, tried to access the site to get insurance as soon as it opened. Just think of where you would be today if you didn't have insurance. Wouldn't you be one of the millions?

Don't blame the law for the incompetent computer geeks hired to develop the software. I 'm sure no one will pay any penalty based on failed software. Let's just hope that our fellow copders on this forum and others who are limited in their medical care because they don't have insurance will be able to get it now.

You are not affected by the ACA so I don't know why you are so worried about it. Let's worry about getting more money for medical research for a cure for us. That's where our energy should go. Jmo

They are extending the period for 6 weeks. It was February 15th, now either February 28th or March 30th. I think most will buy by mid December is the site is working fine. As a former software designer, I can tell you that it should be. I can also tell you that it would have been easier to use a template and have one site per state to reduce the complexity.

Hold on Rita, I'm not blaming the law. You're saying because a person is not personally affected by Obamacare, they shouldn't be concerned when people are having a hard time trying to sign up for it? Sorry you see it that way.

Sorry, Rosy, it sounded to me as if you weren't feeling sorry because people couldn't get insurance and instead were only worried that they may have to pay a penalty. I interpreted your comment incorrectly and I'm glad that we are both concerned about people not being able to get insurance. I know a lot of people are excited about being able to have insurance - especially sick people.

Dave has a lot of insight in what it takes to set up a site with so much on it for so many people. I heard on the news that the sites in the 13 states that chose to set up an exchange on their own rather than depending on the federal government are working fine and a large number of people have already signed up for insurance which will start January 1st. I'm sure everyone hopes the geeks (sorry, Dave) hired by the federal government will get the federal website working soon for the other 37 states. (Yeah, right - everyone).

Zuckerberg/Facebook would be the absolute last people I would want designing a website where security and privacy is so important. They don't know the meaning of the words.To put the problems with the website in perspective, it has 500 million lines of code. Yes, that IS a half billion lines. For comparison sake, Windows 8.1 has 70-80 million lines. Anytime you have code with that many lines:1. It's likely it's written poorly2. It will be riddled with bugs that can take months if not years to fix.Here's a good article from CNN that explains a lot of the problems.http://money.cnn.com/2013/10/23/technology/obamacare-website-fix/index.html?iid=Lead

“As democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heart’s desire at last and the White House will be adorned by a downright moron.” H.L.Mencken 1920

According to the newspaper this morning, New York state has had 179,000 sign up so far. Our site seems to be working. Thankfully, I am on a medicare HMO and I don't have to do anything. 2014 has some changes in my coverage and the premium went up $20 a month, but I can deal. I just want to know that if something happens medically, I am covered.

I also read that if you're not sure what to do or how to navigate the government site, you can go to an insurance agent or broker and they will help you. I'm sure there is a fee, but it may be worth it so that you don't make any mistakes. Also they can help find you the best insurance to fit your needs. A lot of people don't know that and think they have to do it themselves.

Roay, I suppose they are paid the same way one pays for anything today - credit card, debit, etc.

This is my understanding of how the program is designed to work: Anyone who currently has no health insurance or is paying for private insurance on his/her own (not an employer paid plan) goes on the exchange (either set up by his/her state or the federal site) and looks at the various options private insurers (Blue Cross, Humana, United, etc) are offering in his/her state and the premium for it. Everything is supposed to be set up so one can easily compare the different options.

Depending on the state, some people will not go on the exchanges because they qualify for expanded Medicaid, which unlike the exchanges which offer private insurance, is a government insured plan. Some states have refused to expand Medicaid although 95% of it would be paid by the federal government for at least the first few years. In those states, more people will go on the exchanges to find insurance.

Each insurer may offer several plans, e.g. different deductibles, co-pays, includes drug coverage, etc. Once s/he has picked a plan, the next step is to find out if the applicant qualifies for financial help from the government to pay the premiums. Those who do not qualify for Medicaid (not poor enough) may qualify for credits from the government to help them pay for the private insurance they have chosen on the exchange. Whether one qualifies for the credit depends on income so the applicants need to fill out their income from the past year and estimate what it will be for 2014. Recently, an agreement was reached requiring that the info the applicant puts in will be verified to prevent fraud.

Rosy, I hope this is coherent and answers your question. Those of us who had an issue with obtaining insurance coverage in the past have most likely been following this more closely than those who always had insurance. If I made an errors, I'm sure someone will step in and correct me.

Oh, Rosy, it wasn't a stupid question. There has been so much yelling about this law that it's hard to figure out anything about it. I don't know if it's the best law but any law that enables more people to get insurance imo is a good law. It is really scary to be out there without insurance even if one is healthy. As they say, without health insurance, you are one accident (or illness in our case) away from bankruptcy.

Thanks Rita. I know what it's like to be without insurance. When my kids were little we had to pay for a family plan that cost us thousands of dollars a year. I had a sick son and my husband worked 2 and 3 jobs so we could pay for his medicine. We were very young then, and believe me, we went without a lot of necessities. Thank God he was able to get a city job (low pay) but with good insurance that he retired from after 28 years.

I worry for those who are in the same boat today, and hope they will be able to afford the insurance that is being offered, but I think there will still be many that will not be able to pay the premiums. Some of the plans being offered are really not that good and they are costly too. Is it the best law, I have to say no, but only time will tell. Rosy

Rosy, I hope your son has outgrown whatever it was he had as a child. You were lucky to find insurance that would cover him as he had an existing condition. If he still has that condition, under the ACA, insurers cannot deny him coverage. That's a part of the law just about everyone likes. But, it is an exception to insurance law. We buy insurance for something which may happen in the future but hasn't happened yet, e.g., automobile insurance covers future accidents, not past ones.

This provision is of special interest to me because I worked in the area of insurance coverage (commercial liability, not health or auto) for many years and the rule is that insurance is for future claims not present or past ones. One of the seminal cases concerned the Chicago fire in 1871. A warehouse owner saw the fire from his window and immediately bought fire insurance which he had never bought before. The insurer refused to pay for the burned down warehouse on the basis that the insured knew he had a claim. The court agreed with the insurer.

The ACA requires that insurers provide coverage even when someone is already sick. To prevent people from waiting until they are sick to purchase insurance, people who are healthy and don't buy insurance are required to purchase it or pay a fine. While the fine is pretty low for the first year ($95), it is higher for the second year ($325, I think).

The law requires that insurers provide certain minimum coverages which is why people who were paying for insurance but not getting those coverages no longer can have the insurance they have now. Everyone will have more things covered but some may have to pay more.

As far as affording to pay the premiums, the government is going to provide subsidies for people whose income is at a certain level so people without the minimum income set by the government (but more than would qualify them for Medicaid) will get money from the government to help them pay their premiums. A complaint is that the government is helping pay for the insurance and it can't afford it. That's similar to the complaint made wrt Medicare and Social Security - that the programs are too expensive. But, I understand that the ACA will pay for itself in a few years. I haven't looked into how that is supposed to work but that's what the non-partisan economists have predicted.

It always comes down to money and which programs the government should pay for. Recently, I saw that NASA supporters were enraged over cuts and argued that U.S. space exploration will be stopped due to cuts. IMO, health care for everyone is more important and I would rather see money go into the ACA than to NASA.

Both of my sons went to the website to see what it would cost them if they went through obamacare. They found out it would cost them about $20 less per month but they would each have a $5000 deductible compared to the $250 deductible they have now. That's the unfortunate thing. People are rushing to join obamacare but they aren't paying attention to just how much they're really going to have to pay out if they have to use it.

I have several problems with obamacare. #1 - HUGE deductibles; #2 - If your company already has you on their insurance plan but it doesn't cover birth control and some other stuff, it is deemed an unacceptable plan and it will be dropped; #3 - I do not like the fact that if you DON'T get insurance, you will be fined yet if you DO get insurance, there will be a "temporary" fee of $63. That fee will be charged to your insurance company but you know that it will move down the line to the consumer; #4 - How are they going to fine all the homeless people or people who know nothing about this fiasco? And WHY are there exceptions to it? Muslims, Amish, Congress, the boy in the White House and his family to name but a few. If there is something that ALL Americans must have (or be fined), then ALL Americans should have to get it.

I think they should drop the whole thing and just add that people with pre-existing conditions must be covered. Period. If people want to buy plans that pay for birth control, then let them but don't make it a requirement that ALL plans have it.

****************************************************************Do Not Regret Growing Older. It is a Privilege Denied to Many

You can’t change the past but you can ruin the present worrying about the future.

The Bad News: Time flies as you get older.The Good News: You’re still the pilot.

I looked for me and if I bought a policy on the exchange I think it was about $350 a month for a gold HMO plan and $500 for a gold PPO. A gold plan does not have a $5,000 deductible.

Plans in the Marketplace are primarily separated into 4 health plan categories — Bronze, Silver, Gold, or Platinum — based on the percentage the plan pays of the average overall cost of providing essential health benefits to members. The plan category you choose affects the total amount you'll likely spend for essential health benefits during the year. The percentages the plans will spend, on average, are 60% (Bronze), 70% (Silver), 80% (Gold), and 90% (Platinum). This isn't the same as coinsurance, in which you pay a specific percentage of the cost of a specific service.